HISTOLOGICAL AND IMMUNOHISTOCHEMICAL CHANGES IN THE ILEAL NEOBLADDER MUCOSA AFTER EXPOSURE TO URINE FOR LONG TIME
Aly A.M. Shaalan1and Lotfy A. Bendary2
1Department of Histology, Faculty of Medicine, Suez Canal University
2Department of Urology, Faculty of Medicine, Zagazig University
This study was designed to investigate the long-term histological and immunohistochemical changes in mucosa of ileal segment used to make an orthotopic neobladder. For this objective, this study included seven patients. One of them was considered as a control and small specimens were obtained from his ileum during construction of an ileal neobladder after radical cystectomy. The other six patients were considered as an ileal neobladder group. This group was subdivided into three subgroups (each contained two patients) based on the duration that passed after the operation, subgroup (A) after one year, subgroup (B) after three years and subgroup (C) after six years. During their follow up, three cold cup biopsies were taken from the ileal neobladder mucosa of each of these six patients and processed for histological and immunohistochemical study. Histological examination revealed that, at one year after the operation, the mucosa was avillous and infiltrated with mononuclear cells. The mucosa after three years appeared with short villi of variable lengths. But, after six years the mucosa showed flattening of epithelium with short villi. Examination of the different stained sections by image analyzer revealed that at one year after the operation, the villi length, the goblet cell number and cytokeratin-8 content in epithelial cells were markedly reduced but the deoxyribonucleic acid (DNA) contents of nuclei of epithelial cells were markedly increased nearly double that of control. In three years subgroup, the villi reappeared to be of variable lengths but still less than that of control, the number of goblet cell was markedly increased more than control, the epithelial nuclei DNA content was more than control and epithelial cytokeratin-8 content was less than that of control. Lastly in six years subgroup, the length of villi was less than that of control and the epithelium appeared flattened with short villi. Goblet cell number and its staining were less than the control and the other subgroups. The epithelial nuclei DNA content was less than one year and three years subgroups but still more than control and the cytokeratin-8 contents in epithelial cells still less than control but more than that of one year subgroup. In conclusion, the exposure of ileal mucosa to urine resulted in inflammatory response and atrophy of villi, but, by passing time the mucosa flattened and short villi reformed as adaptation to the new environment.